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COURSE REGISTRATION
Form

Section 1: Basic Information

Full name*

Email*

Section 2: Session Selection

Which session(s) will you attend?*

Thursday, January 8 at 6:00 PM

Saturday, January 10 at 11:00 AM

Both sessions

Section 3: Intentional Engagement (Psychological Buy-In)

What feels most stuck or misaligned right now?*

If this course works exactly as intended, what would be different for you?*

Section 4: Experience Level (Optional but Insightful)

Have you previously worked with NLP or mindset-based tools?

Yes, extensively

Some exposure

No, this will be new

Not sure

Section 5: Consent & Commitment

I understand this is a live, experiential course and active participation is encouraged.

Yes

How did you hear about this course?

©2025 Divine Solutions for Life Inc., Covington GA. All Rights Reserved

A Member of Mending Minds Counseling and Coaching Group LLc

Divine Solutions for Life Inc. is a 501(c)(3) nonprofit organization. All donations are tax-deductible.

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